Some specific questions
1) How much regional do you (personally, not just watch) do on your acute pain rotation?
2) Who reads the TEE during the heart cases, cardiologists or anesthesiologists? Can you become TEE certified by the end of residency?
3) Are your ICUs open/closed? How many critical care anesthesiologists are on staff and what are those months like?
4) What transplants do you do?
5) What things do you think need improvement?
6) What is the CRNA relationship like: do they relieve you or do you relieve them when their shift is over?
I will try my best to answer these:
1) I think our regional training is one of the strengths of our program. How we do it is as follows: as a CA-1 you do a 4wk block of acute pain. As the acute pain resident your primary job is rounding on all the post-op blocks and learning how to manage/trouble shoot epidurals. We really don't do much in the way of blocks as a CA-1. As the CA-2, we do a 4wk block as the "block resident". You will spend all day doing epidurals & peripheral nerve blocks. The nice thing is that you just do the blocks, you do not sit for the cases. This really maximizes the #'s that you get. While block resident, a CA-3 is on with you as well. They pretty much handle the overflow that you can't get to because of time constraints. We typically have 2 regional fellows, though they don't steal blocks from you at all. You still get first dibs at everything, and jump into help when you struggle. We really are doing all the major blocks at UW ie paravertebrals, supraclaviculars, axillarys, interscalenes, femoral nerve catheters, etc. After my month, I had ~100 epidurals, ~58 peripheral nerve blocks. We have no in-house OB, so our program sends us to Northwestern for a month for our academic OB experience immediately following our block month. The department owns a nice condo 4 blocks from the hospital that you get to yourself for the month, parking included. By the looks of things, I will have over 200 epidurals by the time my month is done in NW.
2) All TEE's at UW are read by our cardiac anesthesiologists for adults, however I believe that the cardiologists come in for the pediatric hearts. Remember that you can only now achieve "basic TEE" certification through residency training, which is a relatively new pathway. We have had two people take the time to achieve this over the course of the last year. That being said, if you want to achieve the requisite #'s then you need to be proactive and start early. We get to do cardiac as CA-1's here, so if you put in the background study early on for TEE, then you can pick up the #'s you need to get basic certification. The alternative is that you can forget about the specific number and study your butt off for the advanced exam. If you pass the advanced exam, you can get testamur status, which seems to be what many of the private practice folks have. The other bonus with our program, is that their are no fellows competing with you for cases. We also get exposed to some great big vascular cases during our training ie TAA's. Our vascular surgeons are doing many big cases here.
3) The ICU's are considered closed, though I've always thought that term to be somewhat erroneous. The surgeon that did the case is always going to remain involved in guiding the patient's care. We have ~5 anesthesia/cc folks on staff, the rest are a mix of surgeons and pulm/cc. You do 1 month of ICU as a CA-1, 1 month as a CA-2, ICU is an elective during the CA-3 year should you want that. I'm not the biggest ICU fan, but I think we get a great experience. As a CA-2, you are the airway/resuscitation expert on the team (aside from anesthesia attendings). I still vividly remember a case from my ICU experience were I resuscitated, placed lines, intubated, and transported to the OR for emergency surgery without ever seeing my ICU attending. This was scary, but also a great experience for me.
4) We do all the major organ transplants, heart, liver, lung, kidney, pancreas. Our liver program is pretty big, so we do many of these. As a CA-2, you spend a month as the transplant resident doing all of the livers for the month. The heart & lung transplants go to the folks on their cardiac rotations or the most senior person on call at night.
5) We are still ironing somethings out with our ICU rotation. We used to have one large mixed medical/surgical ICU. This has now split into a medical & separate SICU. Thus, their have been some growing pains now that these two are separate. Overall, I would still rate them as a great experience that has made me a stronger physician.
6) I think we have a great relationship with our CRNA's. They are all very friendly and fun to work with. They always get us out of the OR for our case conferences. Provided that it is an appropriate case, they relieve us at the end of the day as well. I have no complaints in regards to our working relationship with the CRNA's
